Diseases of the Colon

Question 1

True or false: there are villi in the colon.

Answer 1

False.

Question 2

What symptoms are suggestive of IBD?

Answer 2

Diarrhea
Cramps
Pain
Bleeding
Extra-intestinal symptoms (scleritis, episcleritis, erythema nodosum, pyoderma gangrenosum)

Question 3

__________ can be helpful in diagnosing IBD, but _____________ is the gold standard.

Answer 3

Imaging; endoscopy

Question 4

Inflammatory bowel disease encompasses which two disorders?

Answer 4

Ulcerative colitis and Crohn’s

Question 5

What are the similarities and differences between ulcerative colitis and Crohn’s?

Answer 5

Similarities: chronic diarrhea, weight loss, and fatigue

UC:

• lower abdominal pain
• hematochezia
• mucus in stool
• tenesmus

Crohn’s:

• mid abdominal pain
• nausea/vomiting
• fistulas
• steatorrhea
• skip lesions

Question 6

__________ can occur throughout the GI tract.

Answer 6

Crohn’s

Question 7

Which IBD disorder has fistulas?

Answer 7

Cronh’s

Question 8

Which IBD disorder has transmural inflammation?

Answer 8

Crohn’s

Question 9

True or false: only UC has ulcers.

Answer 9

False. Crohn’s and UC can have ulcers.

Question 10

Deep, linear ulcers are characteristic of __________, while superficial, confluent ulcers are characteristic of _____________.

Answer 10

Crohn’s; ulcerative colitis

Question 11

Malabsorption is a feature of _______________.

Answer 11

Crohn’s

Question 12

What are the basic categories of treatment options for IBD?

Answer 12

• corticosteroids for flares
• surgery for extreme cases or very young patients
• immunomodulators
• 5-aminosalicylates
• TNF-alpha antagonists

Question 13

It is recommended that those with IBD should have yearly colonoscopies after _______ years with the disease (with biopsies for dysplasia).

Answer 13

seven

Question 14

The colitis that is more common in elderly females demonstrates thickened ____________ on histologic exam.

Answer 14

collagenous band in submucosa (this being microscopic colitis); this is not noticeable on colonoscopy –hence the “microscopic”

Question 15

Ischemic colitis is often triggered by ________________.

Answer 15

vasospasm, dehydration, hypotension, or cardiac insult (essentially anything that limits colonic blood flow); think of this in someone who was previously asymptomatic, such as a patient who was admitted to the hospital without GI symptoms and then later developed bloody diarrhea

Question 16

Causes of ischemic colitis include ______________.

Answer 16

• vasculitis (PAN, HSP, lupus)
• cocaine/amphetamine use
• estrogen or migraine medications
• dehydration (marathon running)
• thrombosis

Question 17

_________ proctitis is diagnosable by the clinical history.

Answer 17

Radiation

Question 18

Diverticulosis risk increases with ________________.

Answer 18

age and fat intake

Question 19

True or false: diverticulosis needs to be aggressively managed.

Answer 19

False. Most are asymptomatic.

Question 20

Hemorrhage occurs in about ____ percent of those with diverticulosis and is usually in the __________ colon.

Answer 20

5; right (ascending)

Question 21

What is diverticulitis?

Answer 21

In patients with diverticula, fecoliths can obstruct the outflow and induce abdominal distension, bowel perforation, abdominal pain, and peritonitis.

Question 22

True or false: diverticulitis needs to be surgically managed.

Answer 22

False. It can be surgically managed –in severe cases – but antibiotics most often cure it.

Question 23

Topical GI steroids are those that ________________.

Answer 23

do not get absorbed (such as budesonide) and thus coat the GI tract

Question 24

What does fermentation of chyme contents in the colon produce? What function does this serve?

Answer 24

Fermentation produces trophic factors that lead to growth and maintenance of the mucosal lining as well as increased motility.

Question 25

What is indeterminant colitis?

Answer 25

A form of IBD with both UC and Crohn’s features (15% of all IBD cases)

Question 26

Crohn’s occurs most commonly in the ______________.

Answer 26

terminal ileum and ascending colon

Question 27

Why are strictures seen in Crohn’s?

Answer 27

Because the chronic inflammation leads to fibrosis

Question 28

True or false: all people with Crohn’s present with granulomas.

Answer 28

False. Only 20%

Question 29

How does the diarrhea from Crohn’s and UC present?

Answer 29

It is usually small-volume and roughly six times per day.

Question 30

Extra-intestinal features are more common in _____.

Answer 30

UC

Question 31

True or false: bad extra-intestinal manifestations typically indicate worsening GI function.

Answer 31

False. Extra-intestinal manifestations do not correlate with GI status.

Question 32

What is the guideline for colon-cancer screening in IBD?

Answer 32

Those with IBD are at increased risk of colon cancer. Yearly colonoscopies are recommended, and if dysplasia is present, then colectomy is indicated.

Question 33

How is microscopic colitis treated?

Answer 33

• anti-diarrheals
• bismuth
• topical steroids
• bile-acid binders (cholestyramine)
• aminosalicylates

It is mildly associated with Crohn’s.

Question 34

What is tenesmus?

Answer 34

Sudden urgency to defecate

Question 35

How should you treat ischemic colitis?

Answer 35

Treat the underlying cause:

• If the cause is dehydration, give fluids.
• If the cause is decreased cardiac output, give ionotropic agents.
• If the cause is hypoperfusion, treat with vasopressors.
• If the cause is a thrombus, treat with thrombolytics.

Question 36

Diverticuli are surrounded only by ___________.

Answer 36

serosa, not muscularis propria

Question 37

Lower-GI bleeding is usually from the ____________.

Answer 37

colon

Question 38

The causes of lower-GI bleed, in order of decreasing prevalence, are ________________.

Answer 38

diverticulosis, AVM, neoplasia, colitis, and iatrogenic

Question 39

Volvulus usually occurs in the ____________.

Answer 39

elderly